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February 2015

Alcohol Interlock ProgramParticipant Guide

ContentsWhat is an interlock? 2

Overview 3

Aim of the interlock program 3

What the Court will order 3

Your responsibilities 3

Costs 3

The Alcohol Interlock Program 4

The courts and the alcohol interlock program 4

Getting your interlock licence 4

Driving with your interlock 6

Offences during the program 7

Compliance and monitoring 7

Completing the alcohol interlock program 8

Financial assistance 9

Moving interstate while on the NSW interlock program 10

More information 10

Appendix 1: Examples of how the program operates 11

Appendix 2: Medical Consultation Certificate – Entry into the Mandatory Alcohol Interlock Program 13

Appendix 3: Interlock Installation Certificate 14

Appendix 4: Interlock Driver Licence Statement and Privacy Declaration 15

The Mandatory Alcohol Interlock Program is a court-ordered penalty for NSW drivers who commit a high range, repeat or other serious drink driving offence on or after 1 February 2015. The alcohol interlock program is another step toward reducing drink driving on NSW roads.

If you are ordered by the Court to participate in the program, you will receive a period of driver licence disqualification and be required to have an alcohol interlock device installed in your vehicle for a minimum of 12 months. This is in addition to any other penalty ordered by the Court.

If you fail to complete the requirements of the court order, you will be disqualified from holding a driver licence for at least five years.

What is an interlock?

Interlocks are electronic breath testing devices linked to

the ignition system of cars, motorcycles and heavy vehicles.

Drivers must provide a breath sample that the interlock

analyses for the presence of alcohol. It prevents the vehicle

from starting if alcohol is detected. Randomly timed breath

tests must also be passed while you drive.

All breath test results, a photograph of the person

providing the sample, and any attempts to tamper with

the device are recorded by the interlock. This information

is used to monitor attempts to drink and drive, and any

breach of interlock licence conditions.

In NSW, all program participants must have a zero blood

alcohol concentration when driving. This means that they

cannot have any alcohol in their system while driving.

This guide includes images of different interlock devices.

Their appearance varies between devices.

Overview

Aim of the interlock programThe aim of the interlock program is to reduce drink driving related deaths and injuries on NSW roads.

The program is designed to help drink drivers separate drinking and driving. It does this by keeping offenders in the licensing system on a closely monitored basis, with the interlock physically preventing drink driving.

A participant’s breath test results are recorded by the interlock and monitored by Roads and Maritime during the interlock period. This is so Roads and Maritime can be confident that a participant has learnt to separate drinking from driving, and

can safely drive without the need for an interlock.

What the Court will orderIf you have been convicted of a high range, repeat or other serious drink driving offence, the Court will order you to complete:

• A licence disqualification period, and

• A minimum period of participation in the interlock program.

This is in addition to any other penalty that the Court may impose, such as a fine or jail term.

The Court may grant an exemption from participating in the interlock program, but only in limited circumstances.

For examples of how the program operates see Appendix 1.

Your responsibilities

Please read the information in this Guide to ensure that you fully understand the program and your obligations. If you have any questions, please contact Service NSW on 13 22 13 or discuss it with your legal representative.

Your involvement in the interlock program comes

with significant responsibilities. Failure to comply with

your interlock licence conditions can result in serious

consequences, including fines, extensions to your interlock

licence period, licence suspension and licence cancellation.

Your interlock licence conditions are that you:

1. Only drive with a zero blood alcohol concentration

2. Only drive a vehicle which is fitted with an interlock

3. Ensure that an interlock is installed in at least one vehicle

4. Only drive the vehicle if you have personally provided the breath sample required by the interlock

5. Attend all medical consultations required under the program

6. Ensure that your interlock is serviced when required under the program

7. Do not drive any motor vehicle if you know that the interlock is not working properly, or has been circumvented or interfered with

8. Do not drive a vehicle which is loaded with dangerous goods that must be placarded under the Dangerous Goods (Road and Rail Transport) Regulation 2014.

If you meet these conditions, the interlock program gives you the opportunity to:

• Drive your vehicle legally

• Learn to separate drinking from driving

• Discuss your alcohol use with a doctor

• Access employment, health, education or other services

• Provide transport for your family and friends.

CostsThe interlock program operates on a user pays basis. You are required to pay all costs of being involved in the program. This includes costs to accredited interlock service providers for installing, maintaining and removing the interlock for each vehicle you intend to drive. You are also required to pay a program administration fee to Roads and Maritime when you apply for an interlock licence. The costs for standard services are about $2,200 a year.

For more detailed costs, check with the accredited interlock service providers.

For information on accredited interlock service providers, see rms.nsw.gov.au/interlock. Concession rates are available to eligible concession card holders (see Financial assistance on page 9).

3Alcohol Interlock Program Participant Guide |

The courts and the alcohol interlock program

When you are convicted of a high range, repeat or other

serious drink driving offence, the Court will order a period

of driver licence disqualification as part of your penalty.

The Court will also order you to complete a period of

participation in the interlock program. The minimum

length of your involvement in the program will be

12 months. The licence disqualification period, and any

other existing disqualifications, must be completed before

you can enter the interlock program.

These penalties will be in addition to any other penalty

imposed by the Court.

Getting your interlock licence

Your participation in the interlock program starts when

Roads and Maritime has issued you with an interlock

licence. Interlock licences are available for drivers,

motorcycle riders and heavy vehicle drivers.

You need to:

• Complete your disqualification period

• Visit your doctor

• Install an interlock in your vehicle.

Once you have done this, you need to apply for your

interlock licence at a Service NSW centre or your local

registry. Interlock licences can take longer to issue than a

normal licence.

You may not be eligible to apply for an interlock

licence if you have any other court imposed licence

disqualifications, or if you have unpaid fines with

the State Debt Recovery Office. If you are unsure

about your eligibility to apply for an interlock

licence, please contact Service NSW on 13 22 13.

Steps you need to complete before you can apply for your interlock licence

a. See your doctor and get your Medical

Consultation Certificate

b. Install your interlock and get your Interlock

Installation Certificate

c. Sign your Driver Licence Statement and

Privacy Declaration.

These steps are explained below.

a. See your doctor and get your Medical Consultation Certificate

Before you can apply for an interlock licence, you must first

visit your doctor. You must see your doctor in the 28 days

before you intend to apply for an interlock licence.

Your doctor will ask you questions about your alcohol

consumption and discuss any issues or concerns.

This is an opportunity to talk about your alcohol use,

health and driving. Your doctor may also refer you for

further treatment.

During the consultation, you must complete and sign the

Medical Consultation Certificate – Entry into the Mandatory

Alcohol Interlock Program (see Appendix 2) with your

doctor. You will need to take this (and the other forms

below) to a Service NSW centre or your local registry when

you apply for your interlock driver licence.

The Alcohol Interlock Program

| Alcohol Interlock Program Participant Guide 4

b. Install your interlock and get your Interlock Installation Certificate

You must have an interlock installed in at least one

nominated vehicle before Roads and Maritime will issue

you with an interlock licence.

Only an accredited interlock service provider can fit an

interlock to your vehicle. A list of accredited interlock service

providers can be found at rms.nsw.gov.au/interlock or by

contacting Service NSW on 13 22 13.

The provider will train you and give you an instruction

booklet on how to use your interlock. If other people

will use your interlock-fitted vehicle, they should also be

trained. This is because whenever they drive the vehicle,

they will need to know how to use the interlock correctly.

All data received from other drivers will be recorded

against your interlock records.

Your provider will also place a label on your interlock stating

that it is a NSW approved interlock device. It is an offence

for you or anyone other than an accredited interlock service

provider to affix, replace or remove this label.

After your interlock is installed, ensure that your provider

signs an Interlock Installation Certificate (see Appendix 3).

You must take this, along with your other forms, to a

Service NSW centre or your local registry when you apply

for an interlock driver licence.

c. Driver Licence Statement and Privacy Declaration

You will be required to acknowledge and agree to all the

conditions of the interlock program before Roads and

Maritime will issue you with an interlock licence.

By signing an Interlock Driver Licence Statement and

Privacy Declaration (see Appendix 4) you confirm that

you understand the conditions of your involvement in the

interlock program and how your data is used and stored.

If you need any of the program’s conditions

explained to you further, you should contact Service

NSW on 13 22 13.

d. Applying for your interlock licence

✔ Checklist: Have you got these signed and completed forms?

1. Medical Consultation Certificate – Entry into

the Mandatory Alcohol Interlock Program,

signed by your doctor

2. Interlock Installation Certificate, signed by

your interlock provider

3. Interlock Driver Licence Statement and

Privacy Declaration, signed by you.

These forms can be found at the back of this guide: see Appendix 2–4.

You can apply for your interlock licence at a Service NSW centre or your local registry.

You will also be required to complete the usual requirements for a licence application, including:

• The standard licence application form

• Completing any knowledge, driving or other test, if required. Roads and Maritime will advise you in writing of any tests you are required to complete.

Alcohol Interlock Program Participant Guide | 5

You will be required to pay all associated costs, including the standard licence fee and an interlock administration fee. For further information on current licensing fees and the interlock administration fee, visit rms.nsw.gov.au.

Your interlock licence will have the letter “l” on the front, indicating that the licence is subject to interlock conditions.

The back of your interlock licence will state that interlock

conditions apply.

Driving with your interlock

Before starting the vehicle, you must blow into the

device. Your breath sample is analysed for alcohol and a

photograph taken before your vehicle will start.

It is your responsibility to ensure that you maintain a zero

blood alcohol concentration when you drive. If you are

detected by NSW Police with any amount of alcohol in your

system, you may be charged with a drink driving offence.

The safest way to ensure that your blood alcohol

concentration is zero is to not drink at all when

you intend to drive, and to also strictly limit your

drinks in the evening if you intend to drive the next

morning. It can take several hours for alcohol to

completely leave your body after drinking. The more

you drink, the longer it will take for your blood

alcohol concentration to return to zero.

To ensure you remain with a zero blood alcohol

concentration throughout a journey, the interlock also

requires additional breath samples while you drive. When

prompted, you should pull over in a safe location to take

the test.

All test results and photographs are recorded by your

interlock, including the test taken when you try to start

your vehicle, and those taken during your journey.


If you fail a breath test at any time, the device will display a

lockout time (for example, 5 minutes or 30 minutes) which

varies depending on your blood alcohol concentration. This

shows how long you must wait before the next test can

be taken. If you know you have been drinking, you may

choose to wait longer before trying again.

If you are locked out a number of times, you may trigger

an early service alert. This means you must have the device

serviced by your provider at additional cost to you.

Offences during the program

At all times while you are on the interlock program, you

must meet your interlock licence conditions (see page 3).

Not doing so could result in fines, extensions to your

interlock licence period and licence disqualification.

In addition to your interlock licence conditions, there are

also other offences which can result in fines and penalties:

• It is an offence for anyone other than an accredited

interlock service provider or their agent to:

– install, maintain or remove an interlock

– label, or remove the label from, an interlock

• It is an offence for anyone to tamper with or otherwise

interfere with an interlock

• It is an offence for you to refuse to allow a police

officer to inspect an interlock

• It is an offence for another person to assist you to start

a vehicle with an interlock (for example, by providing a

breath sample to start the vehicle for you).

Other offences committed during your interlock period

Any period for which your interlock licence is

suspended or cancelled (for example, a demerit

point suspension) will not count towards

completing the interlock period ordered by the

Court. This means extending your time on the

interlock program.

If your interlock licence has been cancelled and you

have not completed your interlock period, you will

remain prohibited from holding anything other than

an interlock licence or learner licence until at least

five years have passed since your original conviction.

You will be eligible to rejoin the interlock program if

you reinstall an interlock.

Compliance and monitoring

You must ensure that your interlock is regularly serviced in

line with the requirements of the interlock program. You

are expected to attend these visits with your vehicle.

Your interlock service provider will advise you when your

interlock is scheduled for a service. These visits may be

scheduled every 60 days, or every 90 days if you live in an

area remote from a provider.

All interlocks have a countdown to alert you to when you

must attend the service. If you do not service your vehicle

within seven days of its due date, the interlock will enter

a permanent lockout. This means you will have to contact

your provider, and possibly incur additional costs.

If you perform well on the program and do not register

failed breath tests, your service visits may be extended from

60 days to 90 days. This will reduce the time you spend

attending service visits.


The device will be maintained and inspected during the service. All data stored in it will be downloaded and sent to Roads and Maritime for monitoring. Any data of other drivers will be recorded against your interlock data.

A physical check will also be made of the interlock device and its labelling during the service to ensure the device has not been tampered with.

If you have registered failed breath tests during your time on the program, you will receive advisory letters and/or health referrals from Roads and Maritime. If you receive one of these letters, you are strongly encouraged to visit your doctor to discuss your use of alcohol and separating drinking from driving. This is another

opportunity to talk about your alcohol use, health and driving.

Completing the alcohol interlock program

In the last six months of your interlock period, you must demonstrate that you can separate drinking and driving before you will be eligible to hold a licence without an interlock condition.

Failed breath tests (even at low range) can result in Roads and Maritime determining that you need to undergo a Fitness to Drive assessment with a doctor before your interlock condition can be removed.

Based on the outcome of this assessment and the review of your interlock data, Roads and Maritime can extend your interlock period for a further six months. At the end of this period, you will need to undertake another Fitness to Drive assessment before you can complete the program.

Roads and Maritime will advise you when your interlock participation period has been completed. When you successfully complete the program, you can go to a Service NSW centre or your local registry to obtain a driver licence that does not carry the interlock condition. You can then organise for your interlock

service provider to remove the interlock from your vehicle.

If you have questions about completing the interlock program, contact Service NSW on 13 22 13.

Financial assistance

Concession rate for interlock services

Interlock service providers offer a concession rate of 35 per

cent off the standard cost of installing, leasing, scheduled

servicing and device removal if you hold a:

1. Pensioner Concession Card – Full rate pension

recipients only

2. Health Care Card – Low income only

3. Department of Veterans Affairs Gold Card endorsed as:

• TPI (totally and permanently incapacitated)

• EDA (extreme disablement adjustment)

• War widow or war widower.

Ask your interlock provider about concessions that may

be available if you think you might be eligible. Provide

evidence of your concession entitlement when you enter

your agreement with your interlock provider when the

device is installed. The provider may need to verify with

Centrelink or Department of Veterans Affairs your eligibility

for a concession.

You need to provide evidence of your entitlement to a

concession on an ongoing basis. If you cannot prove that

you continue to qualify for the concession, the provider

may charge the standard fee.

Severe financial hardship assistance

Additional, short-term financial assistance may be

available from Roads and Maritime for participants in

severe financial hardship. This assistance can range from

partial assistance to the full amount owing to an interlock

service provider.

Assistance is available only upon application by

participants. Assistance is for periods of three months at

a time.

Roads and Maritime will refer you to an assessment agency

that will assess your financial situation and your eligibility

for assistance. Roads and Maritime will advise you in

writing about the outcome of your application.

Financial assistance goes towards covering standard

interlock program fees for installation, servicing and

removal for three months. Assistance is paid directly to the

interlock service provider.

Financial assistance is not available for:

• Extra service visits arising from any non-compliance

with the program

• Removal of the device if you choose to leave the

program before completing your interlock period.

For more information on applying for severe

financial hardship assistance, contact Service NSW

on 13 22 13.


Moving interstate while on the NSW interlock program

Moving to another State and Territory while on the NSW interlock program

If you decide to move to another State or Territory while

you are on the NSW Alcohol Interlock Program, you will be

effectively withdrawing from the NSW program and your

licence will be disqualified. Should you return to NSW, you

will be able to complete the remainder of your program.

Due to different State and Territory requirements, you may

not be able to get a licence in another State or Territory

if you have not completed your interlock period. You will

need to discuss your options with the licensing authority of

the State or Territory to which you are moving.

Moving to NSW from another State or Territory with an interlock licence

If you hold an interlock licence from another State or

Territory and move to NSW, you can enter the NSW Alcohol

Interlock Program.

You can also enter the NSW program if you have been

ordered to enter an interlock program in another State or

Territory but haven’t yet done so.

If you wish to do this, you should contact Service

NSW on 13 22 13 to discuss your situation.

More information

More information about your participation in the

mandatory interlock program can be found on the Roads

and Maritime website at rms.nsw.gov.au/interlock.

Service NSW centres or your local registry will also be able

to help.


Appendix 1: Examples of how the program operates

Example 1: Interlock order

Sentenced: interlock order ➞

Serve licence disqualification ➞

Apply for interlock licence

➞

Complete interlock period

(including meeting

performance requirements)

➞

Return to unrestricted

licence (when Roads and Maritime advises)

Conviction

Receive interlock

exemption order: see Example 2

Example

Offence with a minimum 6 month and maximum 9 month disqualification and a minimum interlock period of 24 months.

1 MAR 2015

Licence disqualification period: 6 months

1 SEP 2015

Interlock period: 24 months (including performance requirements

in last six months)

1 SEP 2017

Note: If you do not complete your interlock period, you may be disqualified from holding a licence other than an interlock licence for at least 5 years from the date of your conviction.

Example 2: Interlock exemption order

Conviction ➞Receive interlock exemption order ➞

Licence disqualified ➞

Complete Sober Driver Program while

disqualified➞

Complete licence disqualification ➞

Apply for unrestricted licence ➞

Return to unrestricted licence (when Roads

and Maritime advises)

Example

Offence with a minimum 12 month and maximum unlimited licence disqualification.

Exemption order

1 MAR 2015

Licence disqualification period: 3 years plus required to complete the Sober Driver Program

while disqualified

1 MAR 2018


Example 3: Interlock performance requirements not met

Conviction ➞Sentenced:

interlock order ➞Serve licence

disqualification ➞Apply for

interlock licence ➞

Complete interlock period ➞

Apply for unrestricted licence ➞

Roads and Maritime finds that performance requirements not met

➞Interlock period

extended by 6 months ➞

Complete a Fitness to Drive assessment ➞

Reapply for unrestricted licence ➞

Return to unrestricted licence (when Roads


Example

Offence with a minimum 9 month and maximum 12 month disqualification and a minimum interlock period of 48 months.

1 MAR 2015

Licence disqualification period: 9 months

1 DEC 2015

Interlock period: 48 months includes Fitness to Drive assessment at the end because performance requirements

not met

1 DEC 2019

Interlock period extended: 6 months (then complete another Fitness to Drive

assessment)

1 JUN 2020

Example 4: Exemption order recipient later wants to join the interlock program

Conviction ➞Receive interlock exemption order ➞

Licence disqualified ➞

Change of circumstances

(e.g. access to vehicle)➞

Contact Roads and Maritime about getting

interlock licence➞

Complete interlock period (including

meeting performance requirements)

➞Return to unrestricted licence (when Roads



Appendix 2: Medical Consultation Certificate – Entry into the Mandatory Alcohol Interlock Program

Alcohol Interlock Program Medical Consultation Certificate Entry into the Mandatory Alcohol Interlock Program

Instructions to applicant STEP 1 Arrange an appointment with your medical practitioner for a medical consultation about alcohol consumption. STEP 2 Complete Section 1 (Personal details) and Section 2 (Applicant's declaration) below. You must sign Section 2.STEP 3 You must take this certificate with you to your medical practitioner. Your medical practitioner must complete and sign both Section 3

(Medical practitioner's certification) and Section 4 (Medical practitioner's declaration).Medical practitioners may visit www.rms.nsw.gov.au/interlock for further information about this medical consultation.

STEP 4 You must take the completed certificate (and any other form required by Roads and Maritime Services as part of your application for an interlock driver licence) to a Service NSW centre or a motor registry to apply for an interlock driver licence.

All sections of this certificate must be completed or your interlock driver licence will not be issued.

1. Personal detailsNSW licence/customer number:

Given names:

This is located at the top left of the letter you received from Roads and Maritime about the Mandatory Alcohol Interlock Program.

Last name:

NSW residential address and postcode:

Mailing address, if different to residential address:

Date of birth:

day month year

Gender:MaleFemale

2. Applicant's declarationI

of

declare that the details I have provided in this certificate are true and complete.

I understand that my personal information is being collected as a requirement of my application for an interlock driver licence. I must supply the information under the Road Transport (Driver Licensing) Regulation 2008. Failure to supply full details and sign this declaration may result in my application for an interlock driver licence not proceeding.

I consent to my information being used as specified in the Privacy declaration below.

Applicant's signature:

day month year

Date:

Page 1 of 1Alcohol Interlock Program – Medical Consultation Certificate - Form no. 7132 (January 2015)

3. Medical practitioner's certification

PRIVACY DECLARATION The personal information provided by you is collected and held by Roads and Maritime Services, Level 9, 101 Miller Street, North Sydney NSW 2060. The personal information held by Roads and Maritime is recorded in the NSW driver licence register. It may be disclosed to Transport for NSW, accredited interlock service providers and persons who provide services to accredited interlock service providers. The personal information may be used to verify the contents of the application, for the administration of driver licensing and vehicle registration legislation, and to research and evaluate the Mandatory Alcohol Interlock Program. You have the right to access or correct your personal information in accordance with relevant privacy legislation. Information about how you can access your personal information is available at www.rms.nsw.gov.au

I hereby certify that (applicant's name):

was seen by me today (date):

day month year

and has undergone a consultation to discuss alcohol consumption.

Medical practitioner's name:

Address and postcode:

Contact phone number:

4. Medical practitioner's declarationI

of


I understand that my personal information is being collected to confirm that the applicant has undergone a medical consultation to discuss the risks of alcohol consumption. Failure to supply full details and sign this declaration may result in the applicant's application for an interlock driver licence not proceeding.


Medical practitioner's signature:

day month year

Date:

Medical practitioner's stamp: Provider number:

Shown on the letter titled 'Advice of disqualification and mandatory interlock order' received by the applicant from Roads and Maritime.

Interlock Participant Number:


Appendix 3: Interlock Installation Certificate

Alcohol Interlock Program Interlock Installation Certificate

Instructions to applicant STEP 1 Arrange an appointment with an accredited interlock service provider to have an approved interlock device installed in your vehicle. For a list of

accredited interlock service providers, go to www.rms.nsw.gov.au/interlock or contact the Service NSW Contact Centre on 13 22 13. STEP 2 Complete Section 1 (Applicant's declaration) below. You must sign Section 1.STEP 3 You must take this form with you to the accredited interlock service provider along with the letter titled 'Advice of disqualification and mandatory

interlock order' that you received from Roads and Maritime.If you are applying for a fee concession, ensure you take evidence of your entitlement for the concession to the accredited interlock service provider. Information on eligible concession cards is available in the Mandatory Alcohol Interlock Program Participant Guide.The accredited interlock service provider must complete and sign Section 2 (Accredited interlock service provider certification) and Section 3 (Accredited interlock service provider's declaration) below.

STEP 4 You must take the completed certificate to a Service NSW centre or a motor registry to apply for an interlock driver licence.All sections of this certificate must be completed or your interlock driver licence will not be issued.

1. Applicant's declarationI

of




Applicant's signature:

day month year

Date:

Page 1 of 1Alcohol Interlock Program – Interlock Installation Certificate - Form no. 1733 (January 2015)

2. Accredited interlock service provider certification

PRIVACY DECLARATION The personal information provided by you is collected and held by Roads and Maritime Services, Level 9, 101 Miller Street, North Sydney NSW 2060. The personal information held by Roads and Maritime is recorded in the NSW driver licence register. It may be disclosed to Transport for NSW, accredited interlock service providers and persons who provide services to accredited interlock service providers. The personal information may be used to verify the contents of your application, for the administration of driver licensing and vehicle registration legislation, and to research and evaluate the Mandatory Alcohol Interlock Program. You have the right to access or correct your personal information in accordance with relevant privacy legislation. Information about how you can access your personal information is available at www.rms.nsw.gov.au

Company name of accredited interlock service provider (tick one)

Name of installer:

GuardianInterlock Systems

Draeger Safety Pacific

Smart Start Interlocks

Address and postcode of where installation was performed:

I hereby certify that at the request of (applicant's name):

I have installed an approved interlock device into the following vehicle:

Heavy vehicleLight vehicle MotorcycleVehicle type (select one):

The interlock device is marked with a 'NSW Approved Interlock Device' label.

Approved interlock device ID number:

Interlock Participant Number: Shown on the letter titled 'Advice of disqualification and mandatory interlock order' received by the applicant from Roads and Maritime.

Participant date of birth:

day month year

Signature of installer:

day month year

Date of installation:

I

of


I understand that my personal information is being collected to confirm that an approved interlock device has been installed in the vehicle identified above. Failure to supply full details and sign this declaration may result in applicant's application for an interlock driver licence not proceeding.


Installer's signature:

day month year

Date:

3. Accredited interlock service provider's declaration

Vehicle registration:

Installer's Personnel Number: From Accredited Interlock Service Provider.VIN (if applicable)


Appendix 4: Interlock Driver Licence Statement and Privacy Declaration

InitialParticipant to initial each statement in the column on the right

Alcohol Interlock Program Interlock Driver Licence Statement and Privacy Declaration

This document outlines the conditions of holding an interlock driver licence and must be completed as part of an application for an interlock driver licence. In order to participate in the NSW Mandatory Alcohol Interlock Program, you must sign and submit this form along with a completed Medical Consultation Certificate signed by a medical practitioner and a completed Interlock Installation Certificate signed by an accredited interlock service provider. To complete this document: STEP 1 Carefully read each requirement for interlock driver licence holders and initial each requirement.STEP 2 Ask a Service NSW centre or motor registry officer to complete the required information and dates on the back of this form.STEP 3 Sign the declaration and give the completed form to the Service NSW centre or motor registry officer, together with your completed Medical

Consultation Certificate and completed Interlock Installation Certificate.

Page 1 of 2Alcohol Interlock Program – Interlock Driver Licence Statement and Privacy Declaration - Form no. 7134 (January 2015)

I acknowledge that I have received and read the Mandatory Alcohol Interlock Program Participant Guide. I agree to comply with the conditions of the program. In particular:

1. I can only drive a motor vehicle when I have a zero blood alcohol concentration.

2. I must only drive a motor vehicle that has fitted to it an approved interlock device installed by an accredited interlock service provider.

3. I understand that if I drink and drive I may be charged with an offence punishable by a fine and/or a term of imprisonment.

4. I understand that, regardless of the blood alcohol reading on my interlock device, it is an offence for me to drive with a blood alcohol concentration above zero.

5. I must not drive a motor vehicle loaded or partly loaded with a placard load within the meaning of the Dangerous Goods (Road and Rail Transport) Regulation 2014.

6. I must submit a form to Roads and Maritime to nominate a vehicle suitable for the licence class(es) that I hold.

7. I must ensure that an interlock device is installed in at least one vehicle that I have nominated at all times.

8. I must ensure that the interlock device installed in any motor vehicle nominated by me is maintained in accordance with the servicing requirements of Roads and Maritime.

9. I must not drive any motor vehicle in which an approved interlock device is installed if the device is not functioning properly, or if any features of the device (including any driver identification features) have been circumvented or interfered with.

10. I must not drive any motor vehicle in which an approved interlock device is installed if any breath sample required to start or operate the vehicle is provided by another person.

11. I must not interfere with, or cause or permit any person (other than an agent of an accredited interlock service provider installing, maintaining or removing the interlock device) to interfere with the proper operation of the interlock device.

12. I must not refuse to allow a police officer to inspect an interlock device fitted to a motor vehicle.

13. I must bear all costs associated with installing, servicing, maintaining and removing the interlock device unless Roads and Maritime provides me with written confirmation that financial assistance will be provided to me for a limited period.

14. I understand that the approved interlock device is programmed to electronically record all information, including blood alcohol levels, attempts to start or tamper with the vehicle, running retests and personal information, including photographic images of the person providing any breath samples and driving the vehicle.

15. I give permission for Roads and Maritime (or such persons as may be nominated by it) or Transport for NSW to use data or information recorded in the NSW driver licence register for the purposes of researching or evaluating the Mandatory Alcohol Interlock Program.

16. I give permission for Roads and Maritime (or such persons as may be nominated by it) to collect data or information in respect of an interlock driver licence holder from an accredited interlock service provider, including information collected by an approved interlock device, for the purposes of administering the Mandatory Alcohol Interlock Program.

17. I acknowledge that Roads and Maritime may provide my personal information held by it in relation to the Mandatory Alcohol Interlock Program to accredited interlock service providers to enable them to exercise functions with respect to the provision of interlock services.

18. I am aware that, throughout my participation in the Mandatory Alcohol Interlock Program, my personal information may be electronically stored by the accredited interlock service providers in jurisdictions outside of Australia.


InitialContinued from page 1

Page 2 of 2Alcohol Interlock Program – Interlock Driver Licence Statement and Privacy Declaration - Form no. 7134 (January 2015)

19. I am aware that Roads and Maritime may consider any relevant data or other information collected by an approved interlock device installed in the motor vehicle nominated by me when considering whether to require me to undergo a medical assessment before varying my interlock driver licence.

20. I am aware that, if my driver licence is suspended during the interlock period, the interlock condition on my driver licence will be extended for a period of time equal to the period of the suspension.

21. I am aware that Roads and Maritime may take licensing action if I remove the interlock device before completing the Mandatory Alcohol Interlock Program or if I fail to complete the program.

22. I am aware that Roads and Maritime may retain the interlock condition on my driver licence if recommended by a medical practitioner following an assessment of my fitness to drive.

23. I understand that if I do not renew my interlock driver licence before it expires my participation in the Mandatory Alcohol Interlock Program for the period during which my licence was expired will not be counted towards my interlock period.

24. If I cease to hold an interlock driver licence before completing my interlock period: • I may be disqualified from holding a driver licence, other than a learner licence or interlock driver

licence, until five years have passed since the date of my conviction, or • If I received a Disqualification Suspension Order for an offence committed before 1 February, 2015,

I will be required to serve the remainder of the full disqualification period (that is, the original disqualification period for this offence minus any period of disqualification I have served to date), and

• Roads and Maritime may refuse an application for any licence without an interlock condition.

From: For a minimum of:

The earliest possible date that you may complete the Mandatory Alcohol Interlock Program and reapply for a driver licence without an interlock condition, based on uninterrupted participation in the Mandatory Alcohol Interlock Program and without any extension of my interlock period, is:

Service NSW centre or motor registry officer to complete the following details

Declaration to participate in the Mandatory Alcohol Interlock Program

Signature:

day month year

Date:

Full name of applicant

NSW residential address and postcode:

NSW licence/customer number:

Signature of CSO / RSO:

day month year

Date:

Service NSW centre or motor registry:

A copy of this form is to be handed to the applicant.

Or until:

OFFICE USE ONLY

Service NSW centre or motor registry stamp:

I acknowledge that I will participate in the Mandatory Alcohol Interlock Program for the applicable interlock period, plus any time during which my interlock period is extended.

I

of




PRIVACY DECLARATION The personal information provided by you is collected and held by Roads and Maritime Services, Level 9, 101 Miller Street, North Sydney NSW 2060. The personal information held by Roads and Maritime is recorded in the NSW driver licence register. It may be disclosed to Transport for NSW, accredited interlock service providers and persons who provide services to accredited interlock service providers. The personal information may be used to verify the contents of the application, for the administration of driver licensing and vehicle registration legislation, and to research and evaluate the Mandatory Alcohol Interlock Program. You have the right to access or correct your personal information in accordance with relevant privacy legislation. Information about how you can access your personal information is available at www.rms.nsw.gov.au

You are required to participate in the Mandatory Alcohol Interlock Program and hold an interlock driver licence for the following period (“the applicable interlock period”):

day month year months / years

day month year

Appendix 4: Interlock Driver Licence Statement and Privacy Declaration cont.


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